Individual
DALLIN ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1494 W. USTICK RD., 110, MERIDIAN, ID 83646
(208) 908-7797
(208) 908-6588
Mailing address
1494 W. USTICK RD., 110, MERIDIAN, ID 83646
(208) 954-0101
(208) 908-6588
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA22062
CA
Other
Enumeration date
04/19/2012
Last updated
10/04/2022
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